Individual provider Active NPI

Cynthia Marie Carter, DO

  • Pediatrics Physician
  • Albuquerque, NM
National Provider Identifier
1568968089
Registry record updated Jul 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
DO2021-0001 Issued in NM
Practice address
5904 Holly Ave NE
Albuquerque, NM 87113-2472
Phone
(505) 298-2505
Fax
(505) 298-2985
NPI assigned
Apr 3, 2018
Last updated
Jul 22, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 22, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X DO2021-0001 NM Primary

Addresses

Primary practice location

5904 Holly Ave NE
Albuquerque, NM 87113-2472

Mailing address

5904 Holly Ave NE
Albuquerque, NM 87113-2472
Phone (505) 298-2505

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250107000047 PA Practitioner - Pediatric Medicine 8426306408 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
DO2021-0001NMMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
STC Pediatrics LLC Pediatrics Current Accepting new patients
STC Pediatrics LLC Pediatrics CurrentSince Jan 1, 2025 Accepting new patients
STC Pediatrics LLC Pediatrics CurrentSince Jan 1, 2025 Accepting new patients
After Hours Pediatrics PC Pediatrics PastSince Jul 28, 2024 Accepting new patients

Locations

160 E Erie Ave
Philadelphia, PA 19134
Phone (215) 427-4067

300 E Hunting Park Ave
Philadelphia, PA 19124
Phone (215) 427-8363

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1522713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721606400000",
    "number": "1568968089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5904 HOLLY AVE NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871132472",
            "telephone_number": "505-298-2505",
            "fax_number": "505-298-2985"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5904 HOLLY AVE NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871132472",
            "telephone_number": "505-298-2505",
            "fax_number": "505-298-2985"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARTER",
        "first_name": "CYNTHIA",
        "middle_name": "MARIE",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-04-03",
        "last_updated": "2024-07-22",
        "certification_date": "2021-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NM",
            "license": "DO2021-0001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

Verify at the official NPI Registry.